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About the IG

This is the technical MedMij FHIR implementation guide based on HL7® FHIR® version STU3.

Purpose

An implementation guide for making use of FHIR in the Dutch context. This guide is developed specifically for use of HL7® FHIR® between personal health environments (PHE) and healthcare provider systems (XIS). PHE and XIS vendors that participate in MedMij conform to a framework of agreements, in Dutch this is called the 'afsprakenstelsel'. HL7 FHIR, or just 'FHIR', plays an important role among those agreements and is used as a standard to exchange health information between the involved parties. The purpose of this guide is to describe use cases and provide technical guidance on how FHIR should be implemented in these situations. The FHIR building blocks, or profiles, involved in these use cases are outlined in this guide. Moreover, this guides provides more textual explanation of these building blocks and describes their relationship and boundaries.

Scope

The scope of this guide includes requirements to enable PHE and XIS in the Dutch realm to use standardized structured data in a defined inter-organizational transaction. Health is a very broad domain. Therefore, MedMij has made scoping choices for its roadmap. MedMij starts with a limited number of medical subdomains, but has the vision to elaborate into more domains later. In scope domains are first described in the functional design that underlies this technical design.

Background

MedMij aims to stimulate electronic information exchange between patients and caregivers. Caregivers generally have access to software applications to help them support their work in treating patients. Software applications for patients are evolving as we speak, but patients typically are not yet enabled to be regarded as a true partner in the care process. MedMij delivers an agreements scheme, in order to enable patients to become that true partner. The section #Afsprakenstelsel describes the relation to this implementation guide.

Information standards have a functional and technical component. The functional part contains definitions of appropriate concepts (dataset) and scenario’s that define when to exchange which of those concepts. The technical part translates the functional scenario’s in an exchange format (such as HL7v3 or FHIR). The stakeholders in MedMij have chosen to introduce FHIR as a modern standard to exchange information in MedMij. A dutch factsheet, that explains why FHIR is chosen is available on the MedMij website. MedMij delivers a FHIR representation (profiles) for each domain in scope.

The program ‘Registratie aan de bron’ (Data capture at the point of Care) has defined Health and Care Information models (zorginformatiebouwstenen or ZIB's) for The Netherlands. ZIB's contain definitions of healthcare concepts. MedMij information standards are mapped to these ZIB's. MedMij creates FHIR profiles based on ZIB's which include mappings to the relevant ZIB concepts. As a result, the created profiles enable context-free implementation. To clarify, these created profiles can be used in a broader context than the described use cases or the MedMij context. This enables interoperability for health information.

Audience

The main target audience of this implementation guide are software vendors and developers that will implement FHIR as part of electronic information exchange under MedMij. This IG is intended for developers of PHR as well as XIS vendors.
Users of this guide are expected to be familiar with the FHIR specification and resource processing. Links to relevant sections of the FHIR specification will be provided. This implementation guide is not intended to be a tutorial on that subject.

Language

This implementation guide is written in English, even though the majority of the documentation in MedMij is in Dutch. A Dutch translation of this document may become available, however, the English version is and remains leading. The rationale for choosing English is as follows. Implementers in healthcare are in many cases foreign, e.g. through outsourcing or because the company is a multinational. But even if they are Dutch native speakers, the educational tracks, their programming language of choice, and the implementer communities they are part of will largely be based on the English language. In creating the documentation for this target audience we have received overwhelming preference from the MedMij implementer community for English. This saves them investments and risks in getting a translation agency on a per vendor basis for each version of the documentation, while at same time not alienating the native Dutch speaking audience. As a side effect it also helps Nictiz in the international realm in discussions with relevant initiatives such as Argonaut (US), Patients Know Best (UK), the Finnish PHR, and the HL7/FHIR community at large.

Afsprakenstelsel

The MedMij information standards are referenced from the 'afsprakenstelsel'. The use of these MedMij information standards should be seen in the context of the 'afsprakenstelsel'. This is applicable to the implementation guidance of the use cases described in this implementation guide.

For example, all use cases performed in the context of a specific authenticated patient, for which an OAuth2 token has been retrieved using the Authentication mechanisms described in the 'afsprakenstelsel'. This token must be passed in each call in the HTTP header named “Authorization”. Each XIS Gateway is required to perform filtering based on the patient associated with the OAuth2 token received for the request, so that only the records associated with the authenticated patient are returned.

Functional design

All use cases described in this implementation guide have a functional counterpart. The functional design pages are written in Dutch. The main overarching wiki page of the functional designs can be found here. From this page you can link to the specific use case through the patient journey image or the table index. It is also possible to link to the specific functional design page from the technical use case pages in this wiki by clicking on the functional circle in the top image.

Use Cases

Implementation guidance is provided per use case on separate wiki pages. The following green circles represent the available use cases. Click on the circle to go to the use case page.